| COMPARISON OF EFFECTS OF EQUIOSMOLAR DOSES OF MANNITOL AND HYPERTONIC SALINE ON CEREBRAL BLOOD FLOW AND METABOLISM IN TRAUMATIC BRAIN INJURY. | |
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MedLine Citation:
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PMID: 21787184 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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The potential superiority of hypertonic saline (HTS) over mannitol (MTL) for control of intracranial pressure (ICP) following traumatic brain injury (TBI) is still debated. Forty-seven severe TBI patients with increased ICP were prospectively recruited in two university hospitals and randomly treated with equiosmolar infusions of either MTL 20% (4 ml/kg; N = 25 patients) or HTS 7.5% (2 ml/kg; N = 22 patients). Serum sodium, hematocrit, ICP, arterial blood pressure, cerebral perfusion pressure (CPP), , shear rate, global indices of cerebral blood flow (CBF) and meatbolism were measured before, and 30 and 120 min following each infusion during the course of illness. Outcome was assessed at 6 months. Both HTS and MTL effectively and equally reduced ICP levels with subsequent elevation of CPP and CBF although this effect was significantly stronger and of longer duration after HTS and correlated with improved rheological blood properties induced by HTS. Further, effect of HTS on ICP appeared to be more robust in patients with diffuse brain injury. In contrast, oxygen and glucose metabolic rates were left equally unaffected by both solutions. Accordingly, there was no significant difference in neurological outcome between the two groups. In conclusion, MTL was as effective as HTS in decreasing ICP in TBI patients although both solutions failed to improved cerebral metabolism. HTS showed an additional and stronger effect on cerebral perfusion of potential benefit in presence of cerebral ischemia. Treatment selection should therefore be individually based on sodium level and cerebral hemodynamics. |
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Authors:
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Vincent Cottenceau; Francoise Masson; Eugenia Mahamid; Laurent Petit; Veniamin Shik; Francois Sztark; Menashe Zaaroor; Jean Francois Soustiel |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-7-25 |
Journal Detail:
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Title: Journal of neurotrauma Volume: - ISSN: 1557-9042 ISO Abbreviation: - Publication Date: 2011 Jul |
Date Detail:
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Created Date: 2011-7-26 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8811626 Medline TA: J Neurotrauma Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Hôpital Pellegrin, CHU de Bordeaux, Service d'Anesthésie Réanimation, Bordeaux, France; vincent.cottenceau@chu-bordeaux.fr. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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